Facilitators and Barriers of Implementing Expanded Sexually Transmitted Infection Screening in California Family Planning Clinics.

Abstract

Background: Reportable sexually transmitted infections (STIs) have increased in California, with dramatic rises in prenatal and congenital syphilis. In response, in 2018 Planned Parenthood Northern California implemented 2 opt-out screening protocols: (1) HIV, chlamydia, gonorrhea, and syphilis co-screening for pregnant patients at pregnancy diagnosis and (2) linking HIV and syphilis screening for all patients.

Methods: Using qualitative analyses, we explored implementation barriers and facilitators that can be addressed by clinical leadership and staff to expand uptake of enhanced screening protocols. Sixteen staff were interviewed across 3 Planned Parenthood Northern California clinics. Primary thematic analysis followed by secondary subanalysis identified themes. Analyses of questions were only included for each interviewee if answered and applicable.

Results: Five themes of commentary emerged, featuring both facilitators and barriers for protocol implementation: patient education/communication, staff education/communication, workflow; patient willingness, and (for protocol 1 only) visit complexity at the time of pregnancy diagnosis. Additional findings included the following: 93% (13 of 14) stated protocols increased syphilis screening and identification; 100% (12 of 12) reported positive impacts on patient care; 42% (5 of 12) noted increases in staff workload, 25% (3 of 12) reported workload improvements over time, and 33% (4 of 12) reported no workload-related impacts; and 86% (13 of 15) reported decreased screening during the COVID-19 pandemic.

Conclusion: Addressing patient and staff education during the beginning stages of implementation may have positive impacts on willingness to adopt new protocols. Consideration of workflow and visit complexity at pregnancy diagnosis may also aid in successful implementation of expanded STI screening protocols in family planning clinics.